Working in Teams

Jelphs, Kim, Dickinson, Helen, Kim Jelphs, Helen Dickinson, Robin Miller

• Publisher: Policy Press
• Year: 2016
• Print ISBN: 9781447329886
• eBook ISBN: 9781447329916
• Edition: 2
• Topic: Medicine
• Subtopic: Health Care Delivery

Working in teams sounds simple but the reality is often more difficult within complex health and social care systems. This revised edition of this essential book brings together cutting-edge thinking about teamworking, and considers how this can be turned into practice within the context of interagency settings. It introduces a range of theories, models and research to demonstrate the benefits – and pitfalls – inherent in teamworking in collaborative settings.

This is a practical and accessible guide focused on how inter-agency teams may be made to function more effectively, illustrated through real-life examples. Its no-nonsense approach will appeal to students, practitioners, team leaders, managers and policy-makers across the health and social care system.

1

What is teamworking and why does it matter?

Teams are an important component of everyday life. If you are employed it is likely that you sit in some form of team; if you are studying you will at some point engage in teamwork for a particular project or activity; and in your leisure time you may play in a sports team or support at least one team. Teamworking is an activity that most of us engage in on a regular basis without even consciously thinking about it. Teams can be incredibly important to us on a human level and contribute to our identity, wellbeing, sense of belonging and community. Similarly, in the context of public services, teams are thought to be important in terms of driving organisational and system performance.

At present, local health and social care communities are under significant pressure as challenges arising from the impacts of austerity measures combine with greater citizen expectations, the vestiges of repeated reorganisations of different government agencies and functions and changes to balances of professional power. Government and non-government organisations alike are tasked with achieving the holy trinity of doing more with fewer resources and in a more joined-up and user-centric way. Dealing with complex and cross-cutting issues while there is such turbulence in the system is no easy thing to achieve, and many individuals and organisations have sought to identify the means through which to improve the performance of their organisations and also the broader systems in which they are embedded.

At least part of the answer to this challenge is effective teamwork. As Glasby and Dickinson argue in the introductory book in this series (see Partnership working in health and social care, 2014a), it is not easy to make partnerships work. Although there are a range of frameworks and models available to aid collaborative working, in practice it is the human factor – the individuals and groups comprising the collaboration – that will ultimately make it a success (or not). At the core of the literature on teamworking is a focus on the human factor.

This book builds on a range of theories, models and research to demonstrate the benefits (and pitfalls) inherent in teamworking, and provides frameworks and practical advice on how teams and inter-agency teams may be made to function more effectively. This edition has been updated since the previous publication in a number of ways, drawing not only on new research evidence, but also on the outcomes of a series of different inquiries into incidents of poor quality care that we have seen emerge globally. In addition to updating the policy context, using more contemporary examples and incorporating global learning about teamworking, we have also sought out more tools and frameworks that can be used by professionals to improve teamwork in their organisations.

In coming to revise this text, one reflection we have as a team of authors is just how much new material has been published on the topic of teamworking across a range of different disciplines. We have sought to synthesise this material and from this extract the kinds of lessons and frameworks that will be of most use to those leading teams in the context of inter-agency working. This kind of activity is important because, although teams are viewed as crucial building blocks across a range of sectors, effective teams cannot be formed by simply grouping individuals together, even though this is often what happens in practice. In the same way that ‘partnership’ became a buzzword in the late 1990s and early 2000s, and ‘community’ and ‘empowerment’ were similarly popular in the 1980s, in recent years ‘teams’ and ‘teamworking’ have become catchphrases within the fields of management and organisational behaviour. Consequently it could be suggested that teams have become the (unspoken) core building blocks of many of the so-called ‘fads’ of modern management (for example, empowerment, business process re-engineering, quality services and management, and the learning organisation).

However, just because something is called a team does not mean that the predicted benefits will simply automatically flow from this arrangement or, indeed, that teamworking is the best way to bring about particular changes. In order to gain the full range of benefits that are associated with teamworking, relationships must be forged between team members, and between teams and the wider organisational environment. Research evidence shows a range of ways in which this process might be enhanced, and this is further explored in the following chapters, as are a series of lessons about what might hinder it. A number of mechanisms for more effective teamworking will likely be recognisable and seem, to some extent, intuitive to many of us. However, within the busy day-to-day world of service delivery, it is these basic building blocks that are all too often overlooked.

Despite criticisms that teamworking might be somewhat of a current fad, there is considerable and growing evidence that effective teamworking can create a significant impact on organisational performance (covered in more detail in Chapter 2). However, it is not just the potential for improvement that is driving this agenda – there are very practical ramifications when teamworking goes wrong. Box 1.1 illustrates the implications of effective and ineffective teamwork with case studies that most of us will be familiar with.

Box 1.1: Case examples of successful and unsuccessful teamworking

One example of the implications of ineffective teamworking that has received significant dissection and debate in the media is the US government’s response to Hurricane Katrina, which hit New Orleans in August 2005. The storm following this weather event flooded New Orleans, and events that followed killed nearly 2,000 people and caused over US$100 billion in property damage. This was despite the fact that weather forecasters had warned the government about the approach of Katrina, and arrangements were in place for an emergency team to respond to this kind of incidence. In the formal report into the disaster response (United States House of Representatives, 2006) several reasons were given for the failure to respond, but key are the unfamiliarity of different agencies with their roles and responsibilities, and confusion over assignments, deployments and the command structure. Communication broke down and key individuals and organisations did not speak to one another enough. Failure to take decisions meant that action was not taken on key issues. Overall, there was uncertainty about who was in charge, and red tape slowed down a number of response processes. Across the world we saw images in the media of the impacts of ineffective teamworking, where journalists were actually out on boats rescuing individuals, as they were the first to reach them.

If we compare this example to the Chilean mining disaster of 2010, we see a very different picture. In this case 33 miners were trapped below ground in the San Jose mine. For the first 17 days there was no contact with the miners, but even after contact was made, the team above ground were predicting that it could take them up to four months to release the miners. However, after just two-and-a-half months, all of the miners emerged. Urzua, the leader of the miners, had rallied the members around a clear goal (surviving), allocated roles linked to skill sets, collectively made decisions, and where issues arose, discussed which solutions were better suited to their end goal (Scandura and Sharif, 2013). The team on the surface also worked well together and, once in contact with the miners, collected appropriate information and used this to help the rescue effort. In this case we saw multiple teams working well individually and also collectively across teams. The organisation above ground worked well with the media to cover the incident in a positive way that would not hamper the rescue effort.

In both these cases serious disasters occurred that had the potential for significant loss of life. Yet in the latter example, clarity of goal, clear delineation of roles and good communication meant that teamwork ultimately had a positive impact. Unfortunately for the residents of New Orleans, the same could not be said, and a lack of coordination and communication led to the death and serious injury of many individuals and events that will have a lasting impact for many.

As these examples illustrate, teamworking does not just come about because we bring a group of people together, and we need to think carefully about how teamworking is supported. This book aims to support those who wish to create effective teams by setting out some of the kinds of factors that are important to consider. In the remainder of this chapter we consider a range of definitions and distinctions that are important to understand when thinking through the different types of teamworking mechanisms that might be necessary within inter-agency contexts. Although teamworking in collaborative settings often involves a much wider range of professional groups with different values, procedures and approaches than more traditional situations, there are certainly lessons from wider, more developed literatures that can inform these processes. The next section considers the relationship between teamworking and collaboration in more detail, before considering what it means to be an effective team, summarising the current UK policy context.

Relationship between teamworking and collaboration

One of the questions that we are often asked is what the difference is between teamworking and collaborative working. When we talk about collaborative working we are often talking about different professionals coming together to work towards particular ends – so this raises the question of whether collaboration is a different thing to teamworking. Inevitably the answer to this question is yes and no, and largely depends on how we use language. A fundamental principle of teamworking is that it involves collaborating with others; similarly, achieving inter-agency collaboration often involves teamworking. In driving improvement it seems that we need both collaborative working and teamworking.

One way to think about the difference between these two concepts is in terms of the contribution that these different literatures make. As Dickinson (2014) notes, the literature on collaboration has predominantly focused on the macro level, being largely concerned with the formal structures and mechanisms that might be used to bring about more joined-up services for users. The introductory book in this series by Glasby and Dickinson (2014a) provides a good account of this literature for those seeking to understand this in more detail. In addition to contributions around the macro level, there are a growing number of accounts that focus on individuals in front-line practice, and an account of this is provided in another book in this series, Managing and leading in inter-agency settings, by Dickinson and Carey (2016). The teamworking literature focuses on the level between formalised structures and individual practice, being concerned with the activities of groups of professionals. In this sense we can think of the contribution of the teamworking literature being at the meso level. If we wish to create effective collaborative working in practice, the reality is that we need to consider factors at all three levels, and it is possible that initiatives at one level may be undermined by those at another if they do not effectively align.

It is sometimes argued that teamworking can be more difficult in inter-agency settings. A classic description of this comes from the Audit Commission (1992, p 20):

Separate lines of control, different payment systems leading to suspicion over motives, diverse objectives, professional barriers and perceived inequalities in status, all play a part in limiting the potential of multiprofessional, multiagency teamwork. These undercurrents often lead to a rigidity within teams with members adhering to narrow definitions of their role preventing the creation of flexible responses required to meet the variety of human need presented … for those working under such circumstances efficient teamwork remains elusive.

While undoubtedly these are challenges, we argue that many of these sorts of characteristics are also present in ‘traditionally’ structured settings (for example, hospitals). In thinking about what sorts of literatures to draw on for this book, we chose to be inclusive and not simply focus on research and evidence derived from inter-agency settings. This has proved to be both a blessing and a curse given that this literature is huge. We tried to select the most appropriate lessons for health and social care collaborations, but inevitably there are trade-offs in terms of what has been included and what we have had to omit. We could have filled this book at least ten times over with possible examples and frameworks, so wherever possible, we have tried to signpost other useful sources that students and practitioners will be able to pursue further.

What do we mean by teams and teamworking?

When reading academic research, one of the challenges is getting to grips with a set of highly specialised terminology that may be unfamiliar unless you have a detailed knowledge of this area. For many individuals reading the teamworking literature, this might not be a problem given that we have noted the familiarity of the concepts of ‘teams’ and ‘teamworking’. However, the ubiquity of the terminology surrounding teamworking is in some ways a challenge in itself. Much as the terminology surrounding collaboration has been used to refer to a wide range of different sorts of working arrangements, ...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• List of tables, figures and boxes
• Acknowledgements
• List of abbreviations
• Preface
• 1: What is teamworking and why does it matter?
• 2: What does research tell us?
• 3: Hot topics and emerging issues
• 4: Useful frameworks and concepts
• 5: Recommendations for policy and practice
• References